Nokea
A client is receiving a nitroglycerin infusion for unstable angina. What assessment would be a priority when monitoring the effects of this medication?
- A. Blood pressure
- B. Cardiac enzymes
- C. ECG analysis
- D. Respiratory rate
Correct Answer: A
Rationale: Since an effect of this drug is vasodilation, the client must be monitored for hypotension.
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The nurse and a student nurse are discussing the specific points about infants born to HBsAg-positive mothers. Which of these comments by the student indicates a need for clarification of information?
- A. The infant will get the hepatitis B vaccine and the hepatitis B immune globulin within 12 hours at birth at separate injection sites.
- B. The second dose can be given at 1 to 2 months of age.
- C. The third dose should be given at least 16 weeks from the second dose.
- D. The last dose in the series is not to be given before age 24 weeks.
Correct Answer: C
Rationale: The third dose should be given at least 16 weeks from the first dose and 8 weeks from the second dose. All of the other options are correct information.
The nurse is caring for clients in the outpatient clinic. A young adult female is seeking help for weight loss. Her weight is 257 pounds, and she is 5'7'' tall.
Which of the following indicates the MOST appropriate diet choices for breakfast?
- A. Applesauce, cream of wheat, toast.
- B. Scrambled eggs and toast, one slice of bacon.
- C. One glass of grapefruit juice.
- D. Bagel with two ounces of cream cheese and a banana.
Correct Answer: A
Rationale: Strategy: Determine the topic of the question. (1) correct-breakfast with some substance won't leave her feeling hungry most of the morning (2) high fat content (3) doesn't provide a balance of nutrients and may leave the client feeling very hungry before lunch (4) high fat content
A 16-year-old client is admitted for elective surgery. The LPN is asked to have the child's mother sign the operative permit. Which action by the nurse is most appropriate?
- A. Have the parent sign the permit form
- B. Refuse to ask the parent to sign the permit form
- C. Ask the unit secretary to have the parent sign the permit form
- D. Have both the child and the parent sign the permit form
Correct Answer: A
Rationale: For minors, a parent or guardian must sign the operative permit, as they provide legal consent for the procedure.
The nurse is caring for a client with a history of pancreatitis.
- A. Which dietary instruction is most appropriate for a client with chronic pancreatitis?
- B. High-fat, low-protein diet.
- C. Low-fat, high-protein diet.
- D. High-carbohydrate, low-fat diet.
- E. Low-carbohydrate, high-fat diet.
Correct Answer: B
Rationale: A low-fat, high-protein diet reduces pancreatic stimulation and supports tissue repair in chronic pancreatitis. High-fat diets exacerbate symptoms, and carbohydrate balance is less critical.
An eight-year-old with cystic fibrosis (CF).
Which of the following dietary requirements should be considered?
- A. High protein, high fat, and high calories.
- B. High protein, low fat, and high calories.
- C. Low protein, low fat, and low carbohydrate.
- D. High protein, high fat, and low carbohydrate.
Correct Answer: B
Rationale: Strategy: Think about each answer choice. (1) contains high fat (2) correct-impaired inTest inal absorption due to cystic fibrosis necessitates a diet higher in protein and calories; fat is decreased because it may interfere with absorption of other nutrients (3) not adequate for this child (4) contains high fat